The aim of this work was to investigate the potential of ultrasound-based optic nerve sheath diameter (ONSD) measurements in detecting raised intracranial pressure in patients with idiopathic intracranial hypertension (IIH) and to describe ONSD response to lumbar puncture. In ten patients with newly diagnosed IIH, transorbital sonography was carried out to assess ONSD, OND (optic nerve diameter), and optic disc elevation before and after lumbar puncture. Twenty-five patients with other neurological disorders served as controls. Subjects with IIH showed a significantly enlarged ONSD on both sides (6.4 ± 0.6 mm vs. 5.4 ± 0.5 mm in controls; p < 0.001). The best cut-off value of ONSD for detecting raised ICP was 5.8 mm with a sensitivity of 90% and a specificity of 84%. After lumbar puncture, ONSD decreased bilaterally (right 5.8 ± 0.7 mm, p < 0.004; left 5.9 ± 0.7 mm, p < 0.043). No post-puncture changes could be observed with regard to OND and optic disc elevation. Sonographic ONSD evaluation may be useful as an additional tool to identify patients with raised intracranial pressure, as in IIH. Furthermore, our data suggest a potential usefulness of this method for monitoring of treatment effects. The degree of ONSD response to lumbar puncture differs in subjects with IIH, which may possibly be related to findings of a defective CSF circulation in the optic nerve sheath in this disorder, a state that is referred to as optic nerve compartment syndrome.
"Several researchers found correlations between ICP and ONSD (Soldatos et al. 2008; Le et al. 2009; Moretti & Pizzi 2009; Moretti et al. 2009), some of them even showed 90% sensitivity and 84% specificity of the ONSD method in patients with intracranial hypertension (Bauerle & Nedelmann 2011). However, in this study, the sample size was very small (only 10 patients). "
[Show abstract][Hide abstract] ABSTRACT: Glaucoma is one of the leading causes of blindness worldwide. Historically, it has been considered an ocular disease primary caused by pathological intraocular pressure (IOP). Recently, researchers have emphasized intracranial pressure (ICP), as translaminar counter pressure against IOP may play a role in glaucoma development and progression. It remains controversial what is the best way to measure ICP in glaucoma. Currently, the ‘gold standard’ for ICP measurement is invasive measurement of the pressure in the cerebrospinal fluid via lumbar puncture or via implantation of the pressure sensor into the brains ventricle. However, the direct measurements of ICP are not without risk due to its invasiveness and potential risk of intracranial haemorrhage and infection. Therefore, invasive ICP measurements are prohibitive due to safety needs, especially in glaucoma patients. Several approaches have been proposed to estimate ICP non-invasively, including transcranial Doppler ultrasonography, tympanic membrane displacement, ophthalmodynamometry, measurement of optic nerve sheath diameter and two-depth transcranial Doppler technology. Special emphasis is put on the two-depth transcranial Doppler technology, which uses an ophthalmic artery as a natural ICP sensor. It is the only method which accurately and precisely measures absolute ICP values and may provide valuable information in glaucoma.
"Based on these considerations, noninvasive measurement of ONSD has been increasingly attempted for monitoring ICP in many clinical settings . Especially, ultrasonographic ONSD assessment has proven to be useful for monitoring high ICP in patients with brain injury, idiopathic intracranial hypertension, and spontaneous intracranial hemorrhage [7,13,14]. "
[Show abstract][Hide abstract] ABSTRACT: Intracranial pressure (ICP) monitoring is an important issue for liver transplant recipients, since increased ICP is associated with advanced hepatic encephalopathy or graft reperfusion during liver transplantation. Invasive monitoring of ICP is known as a gold standard method, but it can provoke bleeding and infection; thus, its use is a controversial issue. Studies have shown that optic nerve sheath diameter > 5 mm by ocular ultrasonography is useful for evaluating ICP > 20 mmHg noninvasively in many clinical settings. In this case report, we present experiences of using ocular ultrasound as a diagnostic tool that could detect changes in ICP noninvasively during liver transplantation.
Korean journal of anesthesiology 05/2013; 64(5):451-5. DOI:10.4097/kjae.2013.64.5.451
"In a prospective study we examined the ONSD in ten adults with newly diagnosed IIH by transbulbar sonography before and after lumbar puncture . Patients were recruited according to the updated diagnostic criteria of IIH and papilledema was documented in all subjects by an ophthalmological examination including funduscopy. "
[Show abstract][Hide abstract] ABSTRACT: B-mode sonography of the optic nerve is a promising new technique in the field of neurology. It may serve as an additional diagnostic tool in different diseases with altered intracranial pressure. The aim of this article is to give an overview on this technique and on its possible clinical applications.
Perspectives in Medicine 09/2012; 1(1-12):404-407. DOI:10.1016/j.permed.2012.01.001
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